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Exploring the Therapeutic Potential of Salivary Exosomes in Corneal Epithelial Wound Healing
Get PDFPURPOSE: This study aimed to evaluate the therapeutic potential of salivary exosomes (SEs) in corneal epithelial wound healing by assessing their effects on wound closure, cellular function, and molecular mechanisms in both in vivo and in vitro models. METHODS: Corneal epithelial wounds were induced in C57BL/6J mice and treated with topical SEs (10 microg/eye) twice daily. Wound closure was monitored using fluorescein staining. In vitro, primary human corneal epithelial cells (HCECs) and human limbal epithelial cells (HLECs) were treated with SEs (0, 5, and 25 microg/mL) to assess migration, proliferation, and mitochondrial function. Western blot and immunohistochemistry were used to evaluate key molecular markers, including integrin alpha6, integrin beta4, thrombospondin-1 (TSP1), and transforming growth factor-beta1 (TGF-beta1). RESULTS: SE treatment significantly accelerated corneal wound closure in vivo. In vitro, SEs enhanced HCEC and HLEC migration, proliferation, and mitochondrial function. SEs upregulated integrin alpha6, integrin beta4, and TSP1 expression in both wounded corneas and cultured HCECs. TGF-beta1 levels were transiently increased in exosome-treated corneas but returned to baseline as healing progressed. Mitochondrial stress assays revealed that SEs enhanced oxidative phosphorylation in HCECs and HLECs. CONCLUSIONS: SEs promote corneal epithelial wound healing by enhancing cellular migration, proliferation, and mitochondrial function while modulating key molecular pathways. These findings suggest that SEs represent a novel therapeutic strategy for corneal injury, warranting further investigation into their mechanisms and clinical applications.The authors thank the Translational Eye and Vision Research Center of Wake Forest University and the Lions Gift of Sight Eye Bank for their technical support. Supported by grants from the National Eye Institute, National Institutes of Health (EY028949, EY035519, EY033330, EY019309)
Perceived Risk of Skin Cancer: Influence of Family History, Age, Ethnicity, and Fitzpatrick Type
No full textPurpose: Skin cancer in the United States accounts for approximately 50% of new early cancer diagnoses. Despite this, many individuals underestimate their personal risk, leading to lower engagement in preventative behaviors. Several factors may influence an individual’s perceived risk, including family history, age, race, ethnicity, skin type, and gender. While some individuals recognize their increased susceptibility based on personal, familial, and cultural experiences, others may have a lower perceived risk due to misconceptions or limited awareness. This study examines how these demographic factors influence individuals' perceived risk of skin cancer. Methods: This study analyzed data from 333 individuals aged 19 to 92. A questionnaire was conducted reporting age, ethnicity, Family History and two subjective classification methods: self-reported skin color descriptors (very fair, fair, olive, light brown, dark brown, and very dark) and self-assessed Fitzpatrick skin type (I-VI). Participants were sorted into generational cohorts based on their age in 2025: Traditionalists (>80 years), Baby Boomers (61-80 years), Generation X (45-60 years), Millennials (29-44 years), and Generation Z (18-28 years). Statistical analysis used a Chi-square test to examine the association between age groups and sun protection behaviors. Results: Chi-squared analysis found that a family history of skin cancer was significantly associated with a higher perceived risk (p < 2.2e-16). Generation cohort was associated with perceived risk. Older generations perceived a higher risk than younger generations (p < 0.001). Fitzpatrick skin type VI showed a significantly different risk perception compared to other skin types (p = 1.355e-09), while no significant differences were found among skin type I-V (p = 0.546). Gender was not significantly associated with perceived risk (p = 0.25). Ethnicity showed a strong association with perceived risk (p < 0.001). White participants were more likely to perceive high risk. In contrast, Black, Hispanic, and Latino participants tended to perceive lower risk levels. Conclusion: These findings highlight the significant influence that family history, age, and ethnicity have on individuals' perceived risk of skin cancer. The strong association between family history and age with risk perception suggests that personal or seen experiences with skin cancer may play a key role in shaping awareness. The lack of significant association between Fitzpatrick skin types and perceived skin cancer risk suggests that the scale is inadequate for assessing individual risk perception. Our study confirms previous studies that have identified the Fitzpatrick scale's weakness in correctly capturing skin color and ethnic diversity that influences risk perception and awareness. Our study confirms the need for redesigning skin cancer risk reduction programs to increase engagement in preventative behaviors
Empowering Patients: Enhancing Pharmacy Education with AI-Powered Chatbot Prompts
No full textBackground: Artificial intelligence (AI) is revolutionizing healthcare, and pharmacy is no exception. AI-powered chatbots like ChatGPT are emerging as valuable tools for patient interaction and education. Education on the emerging role of the pharmacist has ventured into a new arena powered by AI. Pharmacists receive extensive training to make professional judgments related to medication therapy management. However, the emerging role of the pharmacist is not always well understood by patients. Objective: The objective of this study was to investigate the impact of AI-powered chatbots, such as ChatGPT, on patient perceptions of the pharmacist's role and their desire to seek additional information about pharmacy services. Methods: In the summer of 2024, a team of investigators began developing a survey to explore whether ChatGPT led patients to better understand the role of the pharmacist. The overall goal was to compare traditional educational methods and AI-powered tools like ChatGPT to provide valuable insights into the effectiveness of these technologies in patient education. A thorough literature search was conducted using the time frame 2018-2024, PubMed and Google Scholar search engines, and key search terms such as, “patient education,” and “artificial intelligence”. Based on this literature review, a survey was developed that assessed factors such as trust comfortability, cost-savings, and communication. Each survey item was mapped to a relevant article in the literature. Patients were asked to rate their level of agreement on a scale ranging from strongly disagree to strongly agree. The survey was distributed to 100 patients and analyzed using descriptive and inferential statistics to determine the impact of chatbot interactions on patient education and engagement. Results: Preliminary results from our survey suggest that AI-driven prompts can significantly improve patients' perceptions of pharmacists and their willingness to seek additional information about pharmacy services. Findings also revealed that, regarding medication use and management, oftentimes patients do not know what questions to ask. Our research indicates that many patients are unsure and when provided with an AI chatbot they hesitate to share interactive questions, leading to gaps in understanding and engagement. Conclusion: This study provides a compelling overview of the potential of AI in transforming patient education and the perceived role of pharmacists. For future research, we aim to leverage AI-powered chatbots, such as ChatGPT, to enhance patient education by providing tailored prompts that guide patients in asking relevant questions about their medication and the role of pharmacists. As the healthcare landscape continues to evolve, the integration of AI will likely play an increasingly important role in enhancing patient care and education
Incomplete Unilateral Ureter Duplication – A Case Report
No full textThe ureter is a muscular tube that carries urine from the collecting system of the kidney to the bladder for collection and, ultimately, excretion. Of mesodermal origin, the ureter arises from reciprocal induction between the metanephric blastema and the ureteric bud. Deviations from the normal intricate developmental process can lead to congenital anatomical alterations. During a routine dissection of a female cadaver, an incomplete unilateral ureteral duplication was discovered prompting further evaluation of the rare anatomical alterations’ incidence, manifestations, and clinical implications. The discovered ureter originated from two anatomically independent collecting systems from the same kidney that later converged along their course, forming one relatively thicker ureter that feeds into the bladder. Realizing such an anatomical alteration’s overall incidence and presence in patients is essential for healthcare workers as its diagnosis would guide treatment and reduce errors in radiologic studies, bedside procedures, and invasive surgeries
The Hidden Threat: Chronic Urinary Retention and Thromboembolism in Underlying May-Thurner Syndrome
No full textRAD 2025 Award Winning Posters & Oral Presentations, Poster Highlight: Texas College of Osteopathic Medicine - Case StudyBackground: May-Thurner Syndrome (MTS) is characterized by the formation of an intravenous scar or venous “spur” resulting from chronic pulsatile compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) against the fourth or fifth lumbar vertebral body. This compression creates a flow-limiting stenosis of the LCIV, leading to increased intravenous pressure in the veins draining the left lower extremity (LLE). Consequently, this elevated venous pressure manifests as unilateral LLE edema, pain, tenderness, warmth, skin discoloration, and pelvic symptoms such as fullness and dyspareunia. MTS significantly increases the risk of venous thromboembolism, including deep vein thrombosis (DVT) and potentially fatal pulmonary embolism (PE). Here, we present a case of a 79-year-old male with MTS complicated by a near-fatal PE, further exacerbated by chronic urinary retention. Case Presentation: A 79-year-old white male presented to the emergency department in acute distress after awakening with severe shortness of breath. He denied chest pain, fever, chills, paroxysmal nocturnal dyspnea, and leg pain but had traveled more than eight hours by car twice in the previous week. His past medical history included hypertension, hyperlipidemia, coronary artery disease, and benign prostatic hyperplasia (BPH), previously treated with transurethral resection of the prostate. He had no history of asthma, COPD, or prior venous thromboembolism. On examination, he was alert, anxious, and ill-appearing with hypoxia (SpO₂ as low as 80%), hypotension, unilateral LLE tenderness and edema, tachycardia, orthopnea, and diminished breath sounds bilaterally. Echocardiogram indicated a dilated right ventricle. Serial troponin levels were elevated, starting at 0.23 ng/mL, increasing to 0.43 ng/mL after six hours, and rising to 0.56 ng/mL three hours later. Lower extremity duplex examination revealed occlusive DVT in the left common femoral and posterior tibial veins. CT angiogram demonstrated extensive central pulmonary emboli measuring 9 cm, necessitating immediate thrombolysis. Following successful thrombolysis, a CT abdomen with contrast revealed a markedly distended urinary bladder measuring approximately 26 cm in length, 16.5 cm anteroposteriorly, and 16.5 cm wide. This chronic urinary retention resulted in compression of vascular structures, exacerbating LCIV obstruction. Venography demonstrated 100% occlusion of the LCIV with extensive collateralization. The patient underwent percutaneous transluminal angioplasty (PTA) with stent placement, successfully restoring venous flow. He was discharged home on lifelong anticoagulation. At one week, one month, and six months post-procedure follow-up visits, the patient remained asymptomatic with no recurrence of LLE edema or pain and no evidence of stent migration, restenosis, or thrombotic complications. Conclusions: This case highlights the importance of recognizing MTS as a differential diagnosis in patients with unprovoked DVT or PE, particularly in those with risk factors such as chronic urinary retention. While MTS is commonly associated with young females, this case emphasizes its presence in elderly males, where urinary retention due to BPH may serve as a contributing factor. Early identification and intervention in cases of MTS complicated by thromboembolism can be lifesaving. Given the increased prevalence of urinary retention in elderly males, clinicians should consider screening for MTS in patients with unexplained left-sided DVT
Interaction between alcohol use and APOE ε4 and its association with cognition among American older adults from diverse racial/ethnic groups
No full textPoster Highlight: College of Public Health, RAD 2025 Award Winning Posters & Oral PresentationsPurpose: Alzheimer's disease and related dementias pose significant public health challenges, with their complex etiology involving both genetic and environmental factors. Previous research suggests that genetics may influence the relationship between alcohol use and cognition, with the APOE ε4 allele potentially moderating this association. Light to moderate alcohol consumption has been found to have a protective effect on cognition, especially in individuals carrying the APOE ε4 allele, while heavy drinking is linked to poorer cognitive outcomes. This study examines the interaction between alcohol use and APOE ε4 allele on the associations with cognitive domains in diverse populations. Method: The study has a sample size of 3,495 individuals aged 50+, comprising African Americans (AA; n=640), Mexican Americans (MA; n=1,181), and non-Hispanic Whites (NHW; n=1,674) from the Health and Aging Brain Study – Health Disparities. Linear regression was employed to explore the association between alcohol use and related risky drinking patterns, measured by the Alcohol Use Disorders Identification Test (AUDIT) total score, and four cognitive domains: episodic memory, executive function, processing speed, and language, measured by various standardized neuropsychological tests. The model also evaluated if and how such associations were moderated by the APOE ε4 allele. Analyses were stratified on AA, MA, NHW individuals. Results: Significant interaction effects on episodic memory, executive function, and language domains were observed among AA and NHW individuals. For NHW, those with higher AUDIT scores who are carriers of two APOE ε4 alleles showed a decrease in episodic memory, executive function, and language. In contrast, non-APOE ε4 carriers exhibited improvements in these domains with higher AUDIT scores. Among AA, APOE ε4 carriers showed a further decrease in episodic memory, while non-APOE ε4 carriers showed increasing episodic memory with higher AUDIT scores. No interaction effects were found significant among MA individuals. Conclusion: These findings suggest that the interaction between alcohol use and APOE ε4 status significantly influences cognitive outcomes differently across ethnic groups. This highlights the importance of considering ethnic/racial backgrounds when assessing the impact of lifestyle factors on cognitive health in older adults. Further research is needed to understand the mechanisms underlying these interactions to develop targeted interventions for at-risk populations
Development of thyroid carcinoma as 2nd malignancy in patients with neuroblastoma
No full textRAD 2025 Award Winning Posters & Oral Presentations, Poster Highlight: Texas College of Osteopathic Medicine - Case StudyBackground: Neuroblastoma (NBL) is a pediatric malignancy arising from neural crest cells. High risk cases are treated with surgery, chemotherapy, autologous stem cell transplant, radiotherapy, and immunotherapy. Prior research indicates that high risk NBL treatment increases the likelihood for the development of a second malignancy. When monitoring patients at our institution receiving NBL treatment between 2009 and 2024, five out of 151 patients developed a second malignancy in the form of thyroid carcinoma. In this case series, we analyzed the patients’ disease history, treatment modalities, and disease outcomes to hypothesize different factors which may contribute to second malignancy development when receiving NBL treatment. Case Series Information: Charts of the five patients who were met the inclusion criteria were analyzed through Epic. Three out of five patients were diagnosed with NBL in adulthood. All five were white, non-Hispanic, and four out of five were female. All patients also received standard high risk neuroblastoma treatment consisting of surgery, induction, consolidation, and maintenance chemotherapy. Four patients developed thyroid carcinoma after the NBL diagnosis. All patients underwent surgical resection as thyroid carcinoma treatment. One of the patients also developed a third malignancy in the form of acute myeloid leukemia. Sequencing information was obtained on several of the neuroblastoma and thyroid samples. Four patients also had a family history of cancer. Conclusions: One of two pediatric patients achieved complete response while adult cases were more challenging. These varying disease outcomes can partly be explained by genetics. For example, two of the three adult cases had an Anaplastic Lymphoma Kinase mutation in the NBL biopsy which can induce NBL survival in the presence of treatment. Additionally, the other adult case had been diagnosed with Neurofibromatosis 1 which is a risk factor for NBL and thyroid cancer. We also hypothesize that for three of the five patients, NBL treatment could have induced second malignancy development. For example, all the patients were treated with Cyclophosphamide and Etoposide which have been studied for their role in the development of secondary malignancies. Patients also received MIBG therapy which has also been investigated for the development of thyroid carcinoma if adequate thyroid blockage is not used5. Patients, families, and providers must discuss risks associated with NBL treatment, and patients must undergo thorough screening for early detection of second malignancies
Integrating Residents’ Rights and Infection Prevention in Nursing Homes: ICARE Education and Skills Fair Pilot Assessment
No full textPoster Highlight: College of Public Health, RAD 2025 Award Winning Posters & Oral PresentationsBackground: During the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) implemented required regulations in participating nursing homes (NH) to deliver person-centered care (PCC), including infection prevention and control (IPC). Barriers to implementing person-centered IPC (PC-IPC) include variations in understanding how to incorporate IPC and PCC. Post-COVID barriers to implementing PC-IPC included time constraints and variations in understanding IPC and PCC. The Infection Control Advocate and Resident Education (ICARE) program, which integrates evidence-based practices in IPC and residents’ rights, piloted a PC-IPC education and skills fair to address this barrier. The current study describes changes in fair participant knowledge and perceptions. Methods: Expert Recommendations for Implementing Change (ERIC) Domains 3 (adapt and tailor) and 5 (train and educate) were identified as aligning with barriers results in the creation of the ICARE program. The pilot was conducted in two urban and one rural nursing home. Clinical and non-clinical staff were invited to participate. Participants completed stations that integrated residents' rights with core IPC practices, including environment of care, hand hygiene, prevention precautions, catheter-associated urinary tract infection prevention, antibiotic stewardship, and public health emergencies. Upon station completion, a quiz and survey were completed; quiz scores ≥ 80% were considered passing. Participants' demographics, station evaluation, and job benefit perceptions were collected; descriptive analysis was performed. Results: Ninety nursing home staff participated in the fairs. Most participants were female (84%), almost half (49%) were self-described as Hispanic or non-Hispanic Black, and over half were nursing staff (67%). Most participants passed the station quizzes on their first attempt (1.24 attempt average); 90% indicated learning information to enhance job performance, and 88% indicated they better understood the role of residents’ rights in IPC. Compared to the average, participants in the rural facility were roughly 15% less likely to indicate learning information to enhance job performance or understanding the role of residents’ rights in IPC. Conclusion: The ICARE fair improved the nursing home staff’s understanding of PC-IPC by integrating residents’ rights. Rural participants reported a lower understanding of learning outcomes. ICARE is a unique tool that can provide a means for decreasing NH barriers and integrating PCC approaches to IPC practices. These findings emphasize the need for tailored approaches to address barriers in rural settings and ensure equitable education effectiveness across locations
The Association Between Patient Race and Prehospital Drug Assisted Airway Management Approach.
No full textIntroduction: Evidence-based guidelines call for the use of rapid sequence intubation (RSI) during endotracheal intubation (ETI) to minimize adverse events. Black and Hispanic patients are less likely to receive guideline-recommended care across several conditions, however there has been no evaluation of racial disparities in prehospital drug assisted airway management (DAAM) approaches. We aim to determine the association between patient race and prehospital DAAM approach. Methods: We used the 2022 ESO Data Collaborative dataset to analyze patients without cardiac arrest intubated during a 911 activation. We excluded records with missing race or from agencies with fewer than ten RSI intubations. We analyzed four DAAM approaches using the following definitions based on medications administered prior to the initial ETI attempt: RSI (sedative and paralytic), SO (sedative only), PO (paralytic only), and NoMeds (received no medications prior to intubation). We characterized the dataset using descriptive statistics and calculated odds ratios (OR) and 95% confidence intervals, adjusting for age, gender, GCS<8, ETI indication, SpO2<90, SBP<80, and Social Vulnerability Index, to evaluate the association between race and DAAM approach. Results: Of the 11,140,341 911 responses in the dataset, there were 52,619 patients with at least one intubation attempt. There were 11,044 patients with documented race who were intubated outside of cardiac arrest. Among the 6,033 patients treated by an agency with at least ten RSI-intubations, 4,620 (76.6%) were White, 760 (12.6%) were Black, and 515 (8.5%) were Hispanic. DAAM approaches varied: RSI (71.1%), NoMeds (13.9%), SO (13.4%), and PO (1.3%). Black patients had 26% lower odds of receiving RSI than White patients (OR: 0.74, 95% CI: 0.58-0.95), and 65% higher odds of receiving SO (OR: 1.65, 95% CI: 1.24-2.18) than White patients. Conclusion: Black patients were less likely to receive guideline-recommended RSI than White patients. This provides additional data on clinically-important racial disparities in EMS
Treatment Guidelines for Patients with Developmental Disabilities at Substance Use Disorder Treatment Facilities
No full textObjective: There is a common misconception that people with developmental disabilities (DD) are less likely to acquire substance use disorders (SUD). Research shows, however, that while people with DD are less likely to try substances, they are more likely to develop a SUD if they do use substances. There are no national guidelines for SUD treatment for people with DD. The objective of this study is to examine how common it is for SUD treatment centers to have specific treatment guidelines for patients with DD, and what these guidelines entail. Methods: Thirteen providers from SUD treatment centers consented to be virtually interviewed about the treatment guidelines they use for patients with DD at their facilities, if any. The interviews were recorded, transcribed, and reviewed for the following questions: “Do you follow any specific treatment guidelines to treat SUD in someone with DD? If so, what are they? Are they specific for DD?” Specific treatment guidelines and accommodations were identified,. Results: Of the 13 interviewed providers, 2 mentioned specific accommodations for patients with DD. Other facilities provided case-by-case guidance. The most common accommodations across all 13 facilities were giving breaks or having shorter sessions, using repetition, using the teach back method, and involving caregivers. Facilities with specific treatment guidelines had materials designed for individuals with DD, such as videos and worksheets, as well as strategies for improved learning such as roleplaying. Facilities that accommodated patients with DD on a case-by-case basis often used strategies such as referral and soothing patients’ negative emotions. Conclusions: There is very little information on how to adapt treatment for people with co-occurring SUD and DD. Our results found that patients were most often treated with case-by-case accommodations from providers. These accommodations usually involved referral and soothing of emotions rather than improved learning strategies. This study can help standardize treatment guidelines, and create lesson plans and treatment materials for patients with co-occurring SUD and DD